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Hi, everyone. Welcome to our radiological and asked me for first year's event run by the University of Glasgow Radiology Society. My name is Laura. Our recording didn't really work, so I'm just recording this afterwards with their key points because a lot of people asked for the recording because they can make it to the event or wanted to go over stuff that we talked about. Um, so this is our I lows, and they're just based on the Glasgow Year one Phase one I lows. But radiology's radiology and athletes anatomy. It will be relevant everywhere. And so we'll discuss some basic imaging techniques. A little bit of anatomy and then osteoarthritis in particular is named in the Glasgow Year one I lows for the exam. But we included lots of cases and and pathology just to make everything a little bit more interesting and memorable. And we don't expect you to be able to recognize these conditions at your stage, Um, and especially not for your exams, but hopefully it just makes a little bit more fun. So have a go at the multiple choice questions. Feel free to pause this. Think about it. Um, yeah, I hope this is useful. So to begin with, imaging modalities, Um, there's a lot of information on the slides. Um, I'll let you guys pause this to read through it, and I'll point out the main points. And so you can see a diagram about how chest ray chest X ray is taken. Um, there's a source and which fires? Check them X rays through a person's body and onto a receive er plates, which they're standing in front of in the olden days. They wouldn't have this in computerized. Receive er plates. These have white X ray film, and that film is originally white, and when X rays come into contact with it, it turns black. And so the main thing to think about it is that X rays passed through the body and they are blocked by very dense tissues, so metal bone things that contain calcium and and have x rays are blocked. Do not touch the film, and therefore the film remains white, and that's why your bones in metallic objects, they remain white X rays and pass really well through air. On the other hand, so long bowel gas, and that's why in the lungs and air. Look at black and why the surroundings and sort of around the patient see hand you can see on the right hand side. That appears black because there's nothing to block the X rays from passing through, and they turn the film black in between that soft tissue, fat, soft tissue and fluid, and you can kind of see it in between the hands. With the Pam, it looks a bit gray, and that's because some X rays are blocked and some pass through. And when would you perform in an X ray? Um, so it's very good for bony pathologies or fractures. Dislocations. X rays are very quick, very easy. They're cheap and first line investigations and some chest X rays and abdominal X rays and benefits. As I said, they're very fast. It takes seconds. However, they do use ionizing radiation. How much ionizing radiation is used depends on what your imaging, so something like a hand doesn't have that much ionizing radiation, whereas the abdominal X ray contains quite a lot. Um, that's important because you shouldn't be using ionizing radiation and anyone who's pregnant. Um, and young people there is a cancer risk. If you expose people to a lot of ionizing radiations, you should think twice before ordering it, especially in people who are young and you have a lot of their lives left live. Um, another negative is that it's a two D image of a three D structure, so a lot of the structures overlap. You can see in the chest X ray. You've got spine, heart, breast tissue and all sort of overlapping in the same place. Um, so it can be kind of difficult to tell what's what in what's abnormal, which is why we have CT now. Um, so CT is like a fancy X ray machine, and you can see the patient goes in. It's like a doughnut, and it has a rotating X ray source and detector. And that creates a nice, um, 3 60 degree views or body structures. Um, indications so trauma. So it's often used, Um, if you want to look at someone's brain, if you think they might have had a bleed or someone's been, say, car accident and you want to see um, what what the damage is? It's also useful, useful for malignancy, so detecting militancy, assessing like tumours and seeing what structures they invade. And if you see an abnormality on the chest X ray or an abdominal X ray, people will usually go on to have a CT to look at it. Further benefits. It's really fast. Patient's are in the scan er for under 10 minutes, and there's no problem with overlapping structures, and you can see everything quite clearly. Um, some technology allows you to create M three D images of anatomy. And so, for example, um, the coronary arteries, um, or the past a biliary system. And that's good. You can see different types of abnormality, such as strictures and some narrowings in the vessels. However, it does use a lot of ionizing radiation. MRI is a little bit more difficult to describe and to understand the basics of it, um, human bodies contain lots of protons, so they're H plus signs. And when protons come near powerful magnet, which is always on in an MRI machine, and the protons all start facing the same way, so they all face north. So originally they're all north, south, east, west, whatever. And then they come near this magnet and they all start pointing, see north and The MRI machine then releases pulses of radio waves, um so energy, and that causes the protons to go from north to, say east. And and then there are machine stops, those radio waves and and the protons go back to facing whatever where they were before and as they go back to facing the original way, they give off a little pocket of energy little blow packet and and that energy is detected by the machine. The machine does some fancy math, which you don't really need to understand, but it comes out with these really detailed images and and it's really good at soft tissue. It contains a lot of water, so it contains lots of hydrogen ions. And so that's the main use of MRI for soft issues. So brain muscles, layman's and it's really good at showing swelling. So, uh, Dema um, so although it's not useful for in, say, fractures, well, like it's useful for some fractures, which we'll get into later. But it's not your first line for fractures, but it can show swelling if there's been a fracture and we'll talk about that a bit later. Um so benefits good at short issues and there's no ionizing radiation, so it's safe in pregnancy negatives, and it's slow. Patient's often in the machine for 10 2030 40 minutes, and they often have to remain motionless while the machine is doing the scanning, so they will be asked to take a deep breath in and hold their breath. And for several seconds. If your imaging say the chest, um, I can feel quite claustrophobic, Um, so you can see it's not really suitable to all patient's um, and fairs metallic objects. If they're sort of magnetic, they can't go near the scan. Er, um, so someone's got a pacemaker or cochlear implant or prosthetic heart valves. You need to check whether these are MRI safe or not, before you order the scan. MRI is also often not available at smaller hospitals. So if you're out on the Isle of Lewis or something, um, it's unlikely you're going to have an MRI machine available. You don't really need to be able to interpret MRI scans, but you should be able to take note there t one or T two m s one t one m fats bright on t two fats and water bright so the way I remember it is the Terminator one, Arnie's bads. There for water is dark tea to, um, our knee is good. Therefore, water is light. And yeah, you don't really need to understand. And as I said, you need to really interpret love em MRI, especially not your stage. Even finally, your, um, you won't really be asked to interpret them, but you should be able to point out if it's t one or 22. You should also be able to point out whether it's criminal, sagittal or axle. Um, this goes for CT and M R. So criminal scans it comes from crown, so you can see I've got we crown on this man's head. Um, kind of you imagine. Put a crown on yourself and then where your hands are. I think that's kind of how I remember. That's where the body cuts down. And so on the top. Right, which that's a criminal scan. Um, also one another way you remember it is during the club's you get the corona of the sun around it, and that helps. Um, sagittal comes to the word meaning arrow. So if you imagine someone that's been impaled by an arrow if you cut them so you can see the full arrow through it, Um, that would be a sagittal view, and then axle comes from axles. That's the one at the bottom, and you imagine someone with weight. They've got the ax in the middle and how that would sort of cut through them. That is a transverse or actual scan ultrasound again. You don't really need to be able to interpret a lot of the ultrasound, but it's an important test. You should be aware of him, and so it sound waves. They travel into the body and tissues reflect back. And the machine does a lot of complicated math and creates the picture. And you can also use something called a Doppler effect. And that can show the direction of velocity of blood, which is useful if you're not sure if something is a blood vessel or not. Indications. So it's good at differentiating between cysts, which are fluid filled consolidations. So if someone comes to you with assist, um, or a mass, um, see on their neck and you're quite sure if it's a cyst or if it's something solid and ultrasound to be able to tell them apart. And so it's a good for kidneys. Pregnancy there, used all the time and then can you replacement? You can use an ultrasound to find someone's veins and then guide the needle into those veins. Benefits again. No ionizing radiation Negatives is quite technically challenging, so there is room for operator error. Emmett also cannot see air through air or bone M so often you'll emceeing ultrasound reports that the, um, pancreas can't be visualized because it's obscured by bell gas. So that means pathology can be missed. Um, nuclear medicine again you should be aware of it don't necessarily need to interpret it, Um, but the gist of it is patient's are inject, injected or the ingest a radioactive substance. So often it's the radioactive form of glucose. Um, which is taken up by tissues and metabolically active tissues will take up more of this radioactive in glucose, and then a machine can scan a person and pick up. So the image on the left is a pet scan, and you can see the brain is really bright. And because the brain is very meta publicly effective, it takes up a lot of this radioactive glucose. You can also see some bright spots, and so where the kidneys are and then the bladder, and that's just because it's being excreted. And so the main thing is tumor's cancers Very messy. Belly creative will take up a lot, this glucose as well, and they will be described as brights on pit. Um, so pets can be combined with CT, so the one on the left is pets. One in the middle is which is a plain CT scan, and the one on right is a pet CT. So they've been sort of meshed together. Um, so you can see metabolic uptake of this radioactive substance along with the anatomy, so you can tell where the abnormality is. So indications very good for evaluation. Mansour's, uh, evaluation masses see if their cancers are not. And so cancer is highly metabolically active, more likely to seek out radioactive substance and appear bright and good for metastatic disease. We scan someone, see there any bright spots where you wouldn't expect any, and then the image on the bottom. This is accelerating someone's lungs, so they have inhaled a radioactive substance, which is detected by the scan er and Then you can see whether this substance is going through all of the lungs or there's a dead space in the lungs again. You don't really need to interpret. Interpret that. You just need to know that sort of This is a use of nuclear medicine. So, Bone Ian asked me. As I said, our recording didn't work. So we'll run through this and you can kind of look at it in your own time and I'll point at the main things. So the main one for the hand bones the we hand bones and I use the pneumonic She looks to pretty try to catch her. So she starts at number one, and then it goes to it looks and then two pretty. And then, um, try to catch her. So try would be number eight and then you work your work work alone. Another way to remember is R S T. And I've got this down at the bottom. So your radius and then it goes skate for it, and then thumb, they're kind of like in the same side, um, and then trapezoid and trapezium. And so Schepisi, um, kinda ends the same as thumb kind of rhymes with, um And so it's the one beside your thumb. And then trapezoid is the one more in the middle, and and then another one is hamate. You can kind of feel the hook of hamate on your yourself and your palm. If you have a feel and kind of just under your pinky, um, you might be able to have me feel at it. And so we've got we question here. So pathology. So this is a century old female with chronic pain, the stiffness in her fingers. And so this is what she presents with this image on the left and then our right, the X rays that have been taken, So have a think about what the diagnosis could be. So also process osteoarthritis scout, or is it a fracture? So this is an example of osteoarthritis. The findings of osteoarthritis remember them with loss. So there's lots of joint space osteophyte sub Crandall sclerosis sub condo stiffs. So there's this example of a cyst here, Um, in this in the bomb left image and you can see it's like almost looks like a hole in the bone. Um, Subchondral Sclerosis is a thickening or like a whitening of the bone. Um, so the bone kind of should look very similar all the way through. But around the joint, you will see this white just whitening just at the joint edge. That's subchondral sclerosis, osteo fights or bony lumps or spurs. And so the bone kind of looks different, and it's kind of change. Shape a little, um, especially just run the joint and then lots of joint space. And that's always a little loss of cartilage. The cartilage doesn't contain um, calcium, so it's appears black on um X ray. It kind of looks like there's nothing there in between the joint. It's just like a space. And but that's because so when we call the joint space, we're really referring to cartilage. And there's a lot of the joint space because an osteoarthritis, there's a lot of cartilage. Sorry, that's the ice cream van outside my flat. Um, so another case this is 20 old male with hand pain. After he's fallen onto his hands, he's tender in the anatomical snuffbox. So what? Bone has been fractured and skateboard? Linate, fourth metacarpal tomatoes. So, in case you don't know what the anatomical snuffbox is, it's this red triangle outlined. You can see it, um, on yourself. And you can have a we feel into it. If you ever feel you should be able to feel your in radius and then a little bit of the bone that has been fractured, I won't support just yet. And this is what stuff looks Looks like. Um, so have a look and see if you can see a fracture healing. And so this is a skateboard fracture. I've circled it, and this one is important not to miss, because the blood supply for the skate food comes in one direction. Um, so if you fracture the scaphoid and disrupt the blood supply, it's coming in one direction. Everything sort of distal to that blood supply. And is that risk of avascular necrosis? So, um, the case of the scaphoid the blood supply enters distally. You can kind of see it enters at the disciplined and then runs approximately. So if you fracture the waist with approximate part of your scaphoid, then everything sort of more approximate about is at risk. Now skateboard fractures. This one can be seen on X ray. They're not always so. MRI's the gold standards. So if you, um, have someone who presented like this and you think they might have a skateboard fracture, but you do not see an X ray. Sometimes you will repeat the X ray in a week because, um, as healing occurs, if you take another X ray, it kind of appears whiter, so you can see the fracture line where you couldn't before or you take them for MRI. An MRI, as I said, is useful because you can see a Dema or swelling. It's often you can see swelling in the skate. Freud's or you might even see, um, signs of avascular necrosis. This is the elbow I'll run through this and very easy, uh, the pointy bit of your elbows, the electron on, um, of your process of the ulna and that's in purple here and radius is nice. It's got this nice and circular smooth head, and then your humerus is your upper arm bone. So a case 30 year old male. He's got a sore elbow after he fell onto his outstretched hand. So what's the diagnosis? And fracture is a normal anatomical variant, elbow dislocation or osteoarthritis. I'll let you pause it and you can try and work out. And this is a posterior dislocation, so you can see that the radius and element do not align with the humorous. They should be nicely cut together. Um, they should just fit. They don't, um, so this is quite common dislocation. It's the most common dislocation in Children, and it often falls after falling onto net stretch outstretched hands so you can imagine falling onto your outstretched hands. You're kind of shoving your lower arm back or your upper arm remains in place. That's the shoulder. This one is quite complicated. And so I've included some diagrams of the bomb to hopefully help, and you can see the humerus and reds and that articulates with your glenoid fossil, which is into, and you're gonna fall. So it is part of your scapula, and then you've got a couple of processes that come off your scapula. Sor you have your coracoid process, which is in green up here, um, cork roids. I think it comes from the word crow, and it's like a close beak or throws head, and you can see it more in the diagram. It kind of looks like a bird and then you've got your spine of your scapula and your chromium so you can see in the posterior view. In this diagram, the spine, um, comes up, and then your chromium kind of comes around and peaks over the top, and you can kind of see that in through here and your acromioclavicular, a clavicle warm on the clavicle. You're coming in your clavicle. They come into contact, and if you feel along your clavicle, you can kind of feel how it bends. There's like a gap and it kind of bench rounds, and that's your growing. This is, um, a pelvis or hip and X ray. So again, there's your pelvic girdle. That's three bones, which refused. You've got your ileum issue and your pubis. Pubic symphysis is where they meet in the middle. That's number six, and you can see it's not outlined, but you can see your spine. You're coming down as your sacrum, and then you can't really see it on the actually where you can see in the diagram. It comes to a point, and that's your coccyx. You've got your hipbone, that's your femur, and it comes into this nice round process and That's your femoral head that comes into contact with the acetabulum, which is formed by your pelvic girdle. That's your hip chin. This is the knee, so nice and easy. Um, femur comes down patella in front of it. You can feel your patella yourself, and the only thing that kind of moves around in the front of your knee fibula is lateral and your tibia is medial. Your tibia is the bigger one. That's your shinbone. And the way I remember is fibula has an L in it. So it's lateral. Um, so this would be a left leg because if you can imagine the person standing in front of you and figure out which side would be their lateral and they're sort of outside and then fibula has an L. So it's lateral, um, a little bit of the pathology. So this is a century old male, he resents, with the format history of knee stiffness and pain, thinking about what this condition could be. We have talked about it before, so that's we will hint. And what's the management for this condition? So steroids, knee replacement, immune suppression rest and by management, I mean definitive management. What's going to cure this man. What's going to have them running marathons? So we think so. This is osteoarthritis. Um, so again, go through our our loss for findings and osteoarthritis. There's a loss of joint space because there's a loss of cartilage. You can kind of see the bones coming into contact with each other here, um, osteo fight. So you can kind of see the tibia, um, to sort of to be a kind of points at the end. We bit. It's kind of hard to appreciate in this image. Um, if you Google lost your fights, you'll get some good examples. Subchondral sclerosis. You can see there's a whitening just at the joint, um, and subchondral cysts. I don't think I saw any on this one, but there was a good example in the previous slide. If you go back to it and the management would be for this man would be a total knee replacement, and that would have him hopefully feeling a lot better. One of the interesting things, um, if you're ever in an osteoarthritis clinic, is that the decision to replace someone's joint is based more on there and perceived symptoms rather than their X ray. So if someone came in with this nasty looking X ray but was feeling fine and walking about and didn't really have a bother, um, you wouldn't really think about replacing their knee. But someone came in with mild osteoarthritic changes on the X ray, but was having a terrible time was basically bedbound. Then you would maybe consider replacing their knee. So it's a lot more based on patient symptoms rather than just the X ray. Absolute fruit and Uncle Radiology. Um, so my favorite bones are the canoe forms. There's three and ones out lied in yellow and and apparently there, named after the earliest known writing system. Because they look, I think they look like the way stylist, um, and that was used. And they look very similar. And they split into last little intermediate medial. And just below them is my second favorite bone. That's the navicular. So it means the little ship, and you can see it's kind of curved. It kind of looks like a canoe or both. Um, Q. Boyd's, I guess, just looks cuboidal don't really know what else to say about that, and your other bones are better appreciated in the lash of you. And so calcaneus is your big heel bone. Um, Talus. And then remember, Fibula is like actual and and your tibia is your bigger one. So a little bit of cardio respiratory. So this is a chest X ray. There's a lot of anatomy and a chest X ray. Um, I'll point out the main things that you should know. So, as you can see, this is a very busy slight, and I've because I couldn't be bothered, I I tried to draw around it like the other ones, and I just couldn't get it looking nice. So I found this one online, but I've put rectangles purple rectangles around the main things at your stage. You should be able to point out, so you should be able to see the trachea coming down in the midline. It splits at the Carina and split since your right and left main bronchus and kind of see it splitting here. Um, you should be able to point out the heart. Obviously, um, gastric bubble is below the die from sometimes you see it sometimes you don't, um, die from, and you should be able to follow the dye from lying around on both sides and and then look at the cost a phrenic angles. So that's where um, die from sort of meets meets the ribcage, the edge. And those are the main things that you should be able to point out at your stage. So a little bit of pathology. So this is a seven year old boy. Um his parents report that he was happy and fine, and then he swallows something, and now he's come with an acute onset wheeze. Um, so where is the abnormality? You can see there's like, a screw or a nail. And so whereabouts, Is it in the right bronchus, the softest left bronchus or the heart? Just an aspect of foreign body that stuck in the right bronchus. Um so aspect of foreign bodies are more likely to enter the right bronchus because it's straighter and wider than the left. And you should suspect an aspect of foreign body in young Children with sudden onset respiratory symptoms. Another case so special old male acute onset abdominal pain regarding to look at the diaphragm. And there's an abnormality there and think about what this might mean. Um, so is it pneumoperitoneum? Which is a rare in particular, like abdominal cavity. Um, pneumonia, hepatitis? Or is this just a normal anatomical variant? So this is pneumoperitoneum, so it's Aaron. The abdominal cavity. Um, findings can include free air underneath the diaphragm in particular. Look at how thin the diaphragm is like it's so thin it's tiny, Um, but this can be caused by anything that causes sort of air in your abdominal cavity. So bowel perforation, any whole viscous in the abdominal cavity it's perforated will probably cause this, um, but it can be a normal finding following recent abdominal surgery because they often pump the whole load of air into your stomach or your abdomen, not the actual stomach organ. Um, this is a very important finding. It's something you should be able to recognize, and you might not seen it before. Um, but just keep it in. So this is quite tricky case, but I think it demonstrates vascular and asked me quite well. So this is a six year old male presents with tearing pain, his chest. He's got past medical history of hypertension, so there's an abnormality here, and it's affecting one of the vessels so which vessel has been affected? Is it in fear of being a Kaveh femoral artery? The aorta, the pulmonary artery. Now, if you're not very good at anatomy, which, you know, I wasn't good and asked me, And in the first year, and then this might seem quite confusing to you, but this has taken sort of just above the level and of the heart. So these vessels are rising out of the heart. Um, and we've taken a slice at that level, so I have to think about what vessel might be affected. This is aortic dissection. You get a tear in the inner lining in the aorta, and then there's blood to build up. And you kind of get this, uh, false or double Lumen on imaging so you can see outlines in red and orange. It looks like this blood vessel has has been split into two. And And as two women, um, so this is the aorta. And one way to tell us the aorta is if you're taking, um, slices ct slices about the level of the heart, you often see the aorta twice. So you get the ascending aorta anteriorly, and it then curves around and you get the descending or to posteriorly. And so you see the Ortho place. Yellow is your pulmonary trunk, so it arises at the heart and then branches into your right and left pulmonary arches. Green is your superior vena cava is often sort of squished between the aorta and the pulmonary vessels. Um, yeah. I wouldn't really expect you to be able to recognize or remember the findings in this, but hopefully you can think of it. And remember, um, which vessels which? So this is another one, um, to do with the vessels. Um, so it's unfortunate female presents with shortness of breath and the hemoptysis. So she's coughing up blood, and she's then collapsed and say, Any waiting room So D dimer is raised. Um, if you don't know what D dimer is is kind of a very nonspecific blood test. Um, and I don't want to give away what it's used for, but it's used for one of these things. Adolescent blow. Um, so what's the diagnosis? Is it a myocardial in fortune? It's a heart attack. Pneumonia, trauma or pollen e embolism, which is like a blood clot in your pulmonary vessels. So this is upon my embolism, or P specifically a silopi, Um, because it extends into both common arteries. So, as I said, if you take imaging cross section, sort of at the level of the heart, you'll often see the or two twice so you can see the ascending anteriorly descending posterially. The bright vessel is the S V C. And it's bright because this patient has received contrast. Um, it's been injected into them and the picture is being taken as the contrast is going through the S P C in blue is there pulmonary trunk. So it rises out the heart and then splits into right and left, and you can see in the middle there's this gray, darker black thing, Um, which is a blood coal and that obviously shouldn't be there. So, special senses. This is a very, um, this is based on the Glasgow Year One. I lows, um, head and neck. Radiology is very hard. It's very confusing, but there are a couple of things that the unit expect to to be able to point out and to recognize. And so I'll point out what you need to know, and we can ignore everything else for the time being. Um, so this is a CT, um, of someone's head. And I've taken these pictures I've been scrolling through and I've taken three separate pictures. Hopefully demonstrate anatomy to the first one. You can see the eyes you can see a little bit the norms peeking out. And I've taken this just sort of the upper half of the eyes, the one in the middle. You can see a little bit of eyeball, but less than the first image. And this is at the lower part of the eyes and the third one, you can't see the eyes at all. So this is just below eye level, and that's just to help you orientate yourself. I have highlighted the things that you need expect you to know. So they bet you to be able to point out the eyes. Those big circular things, then coming out from them like a retail is the optic nerve. And they expect you to be able to point out the Sinuses there air filled spaces, so they should appear black. So my favorite one is maxillary sciences. They look in there like triangles, kind of triangular shapes and both on actual and, um, Corona view, which is quite handy there. Quite easy to point out, they're the ones that are sort of in your cheeks. And if you have a cold and you bend down and you get, like this full feeling like pain in your cheeks, it's because your maxillary Sinuses are full of gunk. Um, this light green number four, that's your spin on Sinus. That's very posterior, Um, and that is used in, um, pituitary, uh, surgery. So someone has a problem with the pituitary gland. You can go in through their nose and through their Sinus Sinus and access their brain to that which is quite cool. And then your ethnic sciences are just sort of in the middle. You should also be able to recognize the Pinna, and you can kind of see soft tissue poking out of this person's head. Either side. That's the ear. And then you can see the ear canal, which is this air filled, um, space that summer five. And then just a steer to the ear Canal is, um, bone that's filled with lots of pockets of air, and that's your mastoid air cells. I think when I look this up? No one's really sure what they do. Um, it's kind of debated what they do, but they are important to be able to point out. And they're important pathology, which we will see. No. So this is an eight year old boy. He's got four day history of a sore right year with fever. And just in the past day or so, he has presented with pain and swelling behind his ear, which you can see in the picture. Um, you look at his ears with an OTOSCOPE, and you can see the normal ear on the left. Um, so you can see the sim panic membrane You can see through it. You can see some of the Oscars through it. You can see the cone of light, which is the light reflecting back from your school. This is a normal finding. You should see that, um, on the right image, you can see an unhealthy ear. Um, this ear has a problem with it, and the tympanic membrane looks cloudy. It's bulging. It looks red. Looks angry. There's something in the middle ear. Um, so this is crap normal. Um, and then this boy is going to have a CT and the this boy turns out he's got a complication from, um, this infection that he has. Um, so the main thing to point out here in the CT is how to talk through. Um, a CT. If you might look at this and have no idea what you're looking at, I have no idea what it could be and what you should be able to say. This is, uh, actual image. And this is a CT or someone's head. Um, on the patient's left, I can see air. Um, airspaces. That's the mastoid air sales. And I can see them. That's a normal finding. They should be present on the rights and it looks different. They're not filled with air. It's filled with, um, gray stuff, which in this case, is food. So have a think about what this boy could have. Is it acute otitis media, meningitis, common cold or the flu? So this boy has acute otitis media, and he has a complication which is mastered itis, and you can sell that with the scan because his mastoid air cells are filled with this sort of gunk, um, explode and pass and That's a common complication of Titus media. Again, you don't need to be able to pick that up if you know you won't get an exam like a question like this in the exam. But it shows head and neck radiology, for example. You get a left and right, and often only one side will be abnormal. To compare both and see what you see, talk through it. Describe the scan, Um, and even if you don't come to a diagnosis, it's showing how you work through the scan and how you think about it. That's important if anyone ever asked you better in the words, so you can now put this into practice here. So think about how you would talk through this scan, even if you have no idea what it's showing. Um, so this is a 30 year old female. He's got five month history of a block and my nose and reduced sense of smell, um, so compared left with right? So the patient's left hand side, um and you know the sciences should be filled with air, so the right is normal, but on the left hand side, they're not filled with air, and it's filled with, um, something that could be fluid. You know, it's it's a lot of gunk, sort of rubbish. Um, and you can see this one is a the one on the left is a criminal imaged one on the rights axial. So think about the anatomy. I think about what sciences have been affected. So it's ethmoid frontal maxillary or both if point and maxillary So this is an example of chronic sinusitis. Um, and so again, paranasal Sinuses should be filled with air. And here in the maxillary in ethmoid, Sinuses are filled with fluid. Remember what I said maxillary shaped like a triangle so you can see there's two big triangles. Ethmoids are in the midline in between your eyes, frontal, you can't see in the scan. That would be sort of your forehead and and so annoyed. It's very far back. You can't see it here, but again, it's all about talking through the scan and compare left and right. Talk about what you know is normal and point out the abnormal, even if you're not quite sure what the abnormality is. And this is a 50 year old female with left sided sensorineural hearing loss unless sided facial weakness. So central neural means that the sound is going through her ear and her middle ear. Okay, that's all fine. But there's a problem with her nerves or her brain, and that's why she can hear. Um, M right shows this tumor, this bright white spot at the left cerebellopontine angle, and I think about what cranial nerves have been affected. So is it seven and 873, or just on its own? So this is an acoustic neuroma, a k vestibular Sonoma. It's a benign tumor of the Schwann cells and cranial nerve. Eight usually develops that cerebellopontine angle, and it said to look like an ice cream cone, and you can decide for yourself whether it does or does not. Um, and it can compress cranial nerve ate Green Nerve seven. And that's where you get problems with hearing and balance that screening nerve eight and then facial weakness is your facial nerve. And again, um, this is something that you will learn about in the future if you've not learned about it already. But the main thing to appreciate here is remembering your cranial nerve anatomy. Cranial Nerve eight and seven, both have a very similar course. And you can you can see that the diagram here to one of a mass or lesion affects one. The other will often be affected as well. So, G eye and this is an abdominal X ray. Um, these aren't done, um, as much anymore. They're kind of being overshadowed by abdominal CT s. Probably because of Donald CTS are just a lot better demonstrating and after being pathology and Donald actually also use a lot of ionizing radiation and you don't get a lot of them. Most people end up going to have a CT anyway, um, but they are so used and you will be expected to and look at them during your Aussies and when you're on the words. And so I've taking this picture online, which highlighted the large bowel and red. Um, it's quite difficult to appreciate anatomy on a normal abdominal X ray, Which is why I've got lots of cases, too. And with abnormality sort of demonstrate the different, um, anatomical features. Uh, the Lord bell is in red. It's got a large amateur. It's more peripheral and small. Bell small bell hasn't been highlighted, but it's thinner and and now it's narrow and it's more central, and you can see the different sections. So ascending, transverse descending, um, sidelines and the hepatic and splenic flexure. This is an actual image of the abdomen, and I'm sure this looks a bit of a mess. Um, but I've highlighted everything. Um, so liver is on your rights, So think about your asthma. You know, your liver is on your right. It's a huge organ, and so it's taking up most of the space. Number one is your gallbladder. You know, your gallbladder nestles into your liver and quite nicely, and so you can see it peeking out and kidneys. You know, you've got two of them. Um, so they're either sites and all of your explain and bowel just kind of looks like lips of, um, stuff filled with feces and the air. Um, it's kind of messy, but you can see how a lot of that's, um, taking up my bowel. Um, pancreas Looks like a sausage and CT is what I think. Um, so that's number three. And then your aorta is right by, and the middle is often more to the well. It's right on the image, but it's to the patient's left, um, slightly off midline and just anterior to the spine. This is the Corona image. And so you can appreciate, uh, liver again. Huge organ gallbladder nestled between it beneath it. Um, bow. It takes up a lot of space and kidneys source muscles again. I've highlighted all here. And so our case, this is a 30 year old female in presenting with chronic epigastric abdominal pain and which organ has been affected. Kidney, pancreas, liver, stomach. And so I've got an abdominal X ray here at the actual CT, you have to look really closely on the abdominal X ray. As I said before, it's really hard to appreciate normal anatomy, an abdominal X ray, Which is why I've got all this in these cases with pathology, which will hopefully show you where the anatomy is, where you can find it. So if you find an abnormality in the same place in the future, be able to say, Oh, I think this might be ex organ, so have a wee look and see if you can figure it out. This is dry. Pack your status. I've zoomed in on the abdominal. X Ray, and you can see lots of tiny white dots, and that's calcification and that often occurs in chronic pancreatitis. So this is what your where your pancreas is and then I go back, You can see I said, the pancreas is sauces like it kind of cross is, um, it's on the left side of the body. It crosses the midline kind of extends across, and you can see it on the CT. I think it looks quite sausage like on the CT, and it kind of goes all the way across, and it's not filled with air and like Dallas, and it's more of the same color apart from these calcifications. Here's another example, very similar to last case. It's 40 year old female, the three month history of right upper quadrant pain after she eats. So what's the diagnosis? Gastritis, colecystitis, gallstones or cirrhosis again look very closely at the AlDAN a luxury and then also on the CT. These are gallstones, and I'm assuming done on Don't lecture as well. You can kind of see them collecting, um, so they can sometimes be multiple as an abdominal X ray, or they can be solitary and large as you can see in this CT, and they often cause pain the right upper quadrant after eating. Here's another case, and there's a theme here. So it's 30 year old male over the left sided back. Pain, intimacy material. What is the G eye abnormality? Um, so is a kidney stone bell. Cancer. Gallstones are real cancer. Um, so the theme is calcified organs in the abdomen. Um, this is a branching kidney stone. It's a staghorn calculus. You can see it looks like a stag horns and you can see it's been cut out here and they're huge. They take up in the whole kidney. Um, yeah, and you can hopefully appreciate how big the kidney is on the sub Donald luxury. So this is our last case. This is a 70 year old male, and with a three month history, Huma teary in weight loss. So have a look at the CT. Where's the abnormality? It's about hip, bladder, kidney. I'll give you a wee hint. I've taken this axial slice, um, to show the abnormality. So if an organism present, then the abnormality isn't present in that organ because I appreciate the surgical scan shows everything in his body. So this is the bladder cancer. I don't want to say about that. Apart from just to point out, this is where the bladder is, and you can kind of see it's filled with fluid. And then there's this lighter gray mass producing from the wall, and that obviously shouldn't be there. In conclusion, lots of imaging techniques exist, so you should know the basics of chest X ray, CT and right ultrasounds. It's good to think about what they're used for, what they're good at, so they're good at bones like X ray and CT. Are you good at soft tissue like MRI or ultrasounds? Do they contain ionizing radiation, EMS or extra CT? Um, you know, can you can use this and people who are pregnant or not? You should be able to look at a scan, and even if you can't say anything about it, you should be able to say, um, if it's CT or MRI, if it's solid stool criminal or actual, and if it's an Emery scan, you should able to see if it's t one or tea, too. It's one of the best ways to learn that to be We think is by comparing normal with the abnormal. And I find it's a lot easier to remember abnormal images and to think back and think, you know, so really, um, cool case of his static horn renal calculus. And, um, that's why I remember where the kidney is, an abdominal luxury. And therefore, if you see an abnormality, you think in the same place you think you know that might be kidney. And the key to everything, though, is exposure is very tricky, and it's often not got a lot of teaching in your knee. And so I've listed some resources that you can use. And but one of the best resources is when you got on wards to use packs, which is the computer software, and that allows you to access patient scans and, you know, ask about scans. Read the radiology report, ask people to talk through them with you, and hopefully you should get the hang of them and remember to just say what you see, even if you don't know it specifically what something is, Um, just describe it, Um, so you know the sciences. Compare left with right? If relevant, say what normal should look like, you know, I I know the sciences should be filled with air, but this is filled with something else that is abnormal. And that will do you well. But you will impress a lot of people if you can do that. Um, so questions feel free to get in contact with us and please fill out the feedback form. I'm sorry the recording didn't work, and that's just been me talking through afterwards. So I hope that was okay. And and we have a second year event on Thursday, and that's covering different person asked me and and more imaging techniques. So if this was helpful, feel free to come onto that. As I said, it's second year because it's mapped the Glasgow Uni second year I lows. Um, but it's relevant for all years, and we'd love to see you there. Okay,